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General NPI Number Information
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NPI Number | 1053342725
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Entity Type | Organization
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Legal Business Name | NEW LIFE MFT
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | 1305 E PALMDALE BLVD SUITE 10
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City | PALMDALE
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State | CA
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Zip | 93550-4853
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Country | US
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Telephone | 661-947-0137
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Fax | 661-947-0860
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Provider Business Mailing Address
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Address Line | 1305 E PALMDALE BLVD SUITE 10
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City | PALMDALE
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State | CA
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Zip | 93550-4853
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Country | US
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Telephone | 661-947-0137
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Fax | 661-947-0860
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Authorized Official
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Title or Position | PRESIDENT/CLINICIAN
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Name | MR. DOUGLAS GARNER
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Credential | MA, LMFT
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Telephone | 661-947-0137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC022672
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License Number State | CA
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